CyberKnife Radiosurgery in lung cancer

Stereotactic radiosurgery in lung cancer DR.DEBNARAYAN DUTTA, Consultant Radiation Oncologist, Apollo speciality hospital Chennai

Radiosurgery is a non-invasive option in early lung cancer. High dose precise radiosurgery has immense potential. Early data from phase II studies have shown excellent loco-regional control and survival function. CyberKnife Radiosurgery in lung cancer has following advantages: 1.     Cyberknife has the unique technology of ‘see and shoot’. In this technology before each treatment field matching of the target and ‘intra-fraction motion correction’ is done, hence minimal normal lung comes in the radiation field. 2.      Cyberknife has sub-millimeter treatment accuracy. Margin (planning target volume) required (where normal lung comes) is minimal around the target. High dose region volume is minimal with Cyberknife and lung toxicity is expected to be lower compared with conventional treatment. 3.     Cyberknife has the multiple isocentric technique with non-coplanar field arrangement, hence have unmatched conformity index (uniform dose is delivered). Cyberknife use ‘pencil beam’ with multiple small beamlets delivered from various angles (maximum 1200 different position) hence ‘penumbra’ margin is less. 4.     As dosimetry is favorable and total dose delivered with Cyberknife is not higher compared with conventional fraction (usual dose delivered with Cyberknife 60 Gy/3 fr/ 1 week) there is no expected increase in lung toxicity with Cyberknife. Phase II prospective studies with Cyberknife have not shown any increase in radiation induced pneumonitis. 5.     ‘STAR trial’ is a multicentric randomized study initiated by MD Anderson Cancer Centre may provide answer to impact of Cyberknife on lung toxicity. There are other few ongoing clinical studies with hypofractionated radiation therapy on lung cancer that will provide useful information in near future   For more information of successful treatments using cyberknife you may please blog your comments or write to lakshmipriya_b@apollohospitals.com Radiosurgery in brain tumours Short course radiation therapy is the one of the most talked about subject in recent years and also a fascinating research zone. Hypofractionated radiation therapy is an old concept, but only in recent years with tremendous improvement in radiation therapy delivery technologies there is a significant visible surge in it’s applicability in clinical practice. Modern radiation therapy technology is capable of delivering high dose to the target while sparing majority of the adjacent critical structures. Hence, it is possible to deliver short course of treatment regimen with higher dose per fraction without increasing in toxicity. In brain tumours, radiosurgery with gamma-knife is considered standard of care in many of the clinical indications such as small meningiomas, acaustic schwannomas, residual low grade gliomas, AVMs and solitary/ oligo brain metastasis. Gamma-knife radiosurgery is in clinical practice for more than five decades.  There are several prospective and randomized studies (level I evidence) with long-term follow up data supporting the use of radiosurgery in these clinical indications. Other indications of radiosurgery are pituitary tumour, craniopharyngiomas, glomus tumours, chordomas and others. Robotic radiosurgery (CyberKnife®) is precision radiosurgery delivery system and an extension of gamma-knife system. CyberKnife uses the principle of gamma-knife, but with linear accelerator source instead of multiple cobalt sources. CyberKnife is capable to treating all tumours indicated for gamma-knife with similar accuracy. This modern tool has some additional advantages from gamma-knife, such as 1) CyberKnife can use fractionated treatment, hence relatively larger tumours can be treated, 2) require only thermoplastic mask, no need for invasive frame, 3) has inverse planning system, can spare critical structure, 4) there is a ‘intra-fraction’ correction technology with imaging, 5) there is no need to change the source, hence may be more cost effective and 6) can be used to treat extra-cranial tumours also. CyberKnife has a linear accelerator attached with a robot and is capable of treatment from various coplanar and non-coplanar field arrangements. CyberKnife has sub-millimeter accuracy and unmatched dose distribution.  The advanced technology behind CyberKnife uses image guidance technology and computer-controlled robotics to deliver and extremely precise dose of radiation to targets, avoiding the surrounding healthy tissue, and adjusting for patient and tumor movement during treatment. In conclusion, CyberKnife is an extension of gammaknife radiosurgery delivery system. This machine has immense promise to treat with short course regimens with high dose and improve local control without increasing toxicities.

Factors influencing quality of life in adult patients with primary brain tumors

Factors influencing quality of life in adult patients with primary brain tumors

Rakesh Jalali and Debnarayan Dutta

NeuroOncology Group, Tata Memorial Hospital, Mumbai, India (R.J.); Apollo Specialty Hospital, Chennai,

India (D.D.)

We performed a literature reviewwith respect to factors influencing health-related quality of life (QOL) in adults with

primary brain tumors. A comprehensive, peer-reviewed literature search was performed including studies examining

QOL in adults with high-grade gliomas and lowgrade gliomas and in routine neuro-oncology practice. The interpretation and implication of QOL domain scores may be different in high-grade, low-grade, and benign brain tumors. Several patient-related, treatment-related, and sociocultural factors influence QOL scores. Pretreatment baseline QOL domain scores have been shown to be a predictive parameter for survival function. Implementation of QOL scores in routine clinical practice is underused. QOL is an important outcome measure in the treatment of patients with brain tumors and should be incorporated as a surrogate end point along with traditional end points, such as disease-free and overall survival in most current trials.

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Lung metastases treated by CyberKnife at 41 months.

OBJECTIVES:


Based on the reported success of stereotactic body radiotherapy in treating extracranial tumors, we used CyberKnife to treat patients with metastatic lung cancer.

METHODS:

This is a retrospective report of treatment details and outcomes of 35 patients, ranging in age from 33 to 91 years, with 69 histologically proven pulmonary metastases, treated by image-guided robotic stereotactic radiosurgery Tumor volumes ranged from 0.7 mL to 152 mL. Total doses ranged from 5 to 60 Gy delivered in one to four fractions with an equivalent dose range from 6 to 110 Gy NTD delivered in 2-Gy fractions assuming an alpha/beta of 20 Gy.

RESULTS:

All patients tolerated radiosurgery well with fatigue as the main side effect. Grade 3 and grade 4 pulmonary toxic reactions were observed in one patient who had undergone a repeat treatment. Of the 35 treated patients, 27 (77%) were still alive at a median 18-month (range 2-41 mo) follow-up. Local control was 71% with 25 tumors showing a complete response, 16 a partial response, and 7 stable with disease. Eight had progressive disease.

CONCLUSIONS:

The delivery of precisely targeted radiation doses to lung tumors in a hypofractionated fashion is feasible and safe. Image-guided robotic stereotactic radiosurgery of pulmonary metastases with the CyberKnife achieves good rates of local disease control with limited toxicity to surrounding tissues and in many cases may be beneficial for patients for whom surgery is not an option.

Source : http://frederickcyberknife.com/physician-info/research-articles/

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Treatment of spinal tumors using cyberknife fractionated stereotactic radiosurgery: pain and quality-of-life assessment after treatment in 200 patients.

OBJECTIVE:


Benign and malignant tumors of the spine significantly impair the function and quality of life of many patients. Standard treatment options, including conventional radiotherapy and surgery, are often limited by anatomic constraints and previous treatment. Image-guided stereotactic radiosurgery using the CyberKnife system is a novel approach in the multidisciplinary management of spinal tumors. The aim of this study was to evaluate the effects of CyberKnife stereotactic radiosurgery on pain and quality-of-life outcomes of patients with spinal tumors.

METHODS:

We conducted a prospective study of 200 patients with benign or malignant spinal tumors treated at Georgetown University Hospital between March 2002 and September 2006. Patients were treated by means of multisession stereotactic radiosurgery using the CyberKnife as initial treatment, postoperative treatment, or retreatment. Pain scores were assessed by the Visual Analog Scale, quality of life was assessed by the SF-12 survey, and neurological examinations were conducted after treatment.


CONCLUSION:

CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile

Source : http://frederickcyberknife.com/physician-info/research-articles/

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Image-guided stereotactic body radiation therapy in patients with isolated para-aortic lymph node metastases from uterine cervical and corpus cancer.

PURPOSE:


The aims of this study were to evaluate the role of stereotactic body radiation therapy (SBRT) as a local treatment for isolated para-aortic lymph node (PALN) metastases originating from uterine cervical and corpus cancer.

METHODS AND MATERIALS:

We retrospectively enrolled 30 patients with isolated PALN metastases originating from uterine cervical and corpus cancer who had received SBRT using the CyberKnife (CK). All patients were shown to have isolated PALN metastases by computed tomography (CT) and/or positron emission tomography (PET)-CT. The overall survival (OS), local control (LC) rate, and disease progression-free survival (DPFS) rate were calculated according to the Kaplan-Meier method. Comparison between prognosis groups was performed using log-rank analysis. Toxicities were also evaluated.

CONCLUSION:

The OS and LS rates were promising, and the incidence of toxicities was low. Use of SBRT with the CyberKnife is an effective modality for treating isolated PALN metastases in patients with uterine cervical and corpus cancer.

source :

http://frederickcyberknife.com/physician-info/research-articles/

For more information you may blog your comments or write to lakshmipriya_b@apollohospitals.com